Chadron Vision Center, Inc.

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

CHADRON VISION CENTER, INC.

Practice address

241 E 3Rd St
Chadron, NE 69337-2301

Phone

(308) 432-3222

Fax

(308) 432-5344

NPI assigned

Sep 27, 2005

Last updated

Jul 6, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Timothy L. Chancellor, O.D.NPI 1417916321

Title

Owner / Optometrist

Phone

(308) 432-3222

Specialties & licenses 1

Addresses

Other identifiers 11

Other names 1

• Chadron Vision Center Other name

Medicare fee-for-service enrollment

Enrolled in NE

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Winckler Vision Center, Inc.

  • Optometrist
  • Pine Ridge, SD
  • NPI 1134142243

  8123073574

  Same PAC ID

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Chadron Vision Center, Inc.

  • Optometrist
  • Gordon, NE
  • NPI 1972533354

  O20050317001024

  Same enrollment

Locations

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Chadron Vision Center, Inc.

  • Optometrist
  • Gordon, NE
  • NPI 1972533354
  NPPES parent name

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Timothy Lee Chancellor, OD

  • Optometrist
  • Chadron, NE
  • NPI 1417916321
  Medicare reassignment Care Compare group NPD Authorized official
• Bradley C Marcy

  • Optometrist
  • Gordon, NE
  • NPI 1336581503
  Medicare reassignment Care Compare group NPD
• Mark R Winckler, OD

  • Optometrist
  • Pine Ridge, SD
  • NPI 1538268388

  NE

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1127779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1309910400000",
    "number": "1245226984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "241 E 3RD ST",
            "city": "CHADRON",
            "state": "NE",
            "postal_code": "693372301",
            "telephone_number": "308-432-3222",
            "fax_number": "308-432-5344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "241 E 3RD ST",
            "city": "CHADRON",
            "state": "NE",
            "postal_code": "693372301",
            "telephone_number": "308-432-3222",
            "fax_number": "308-432-5344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHADRON VISION CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-27",
        "last_updated": "2011-07-06",
        "status": "A",
        "authorized_official_last_name": "CHANCELLOR",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "OWNER / OPTOMETRIST",
        "authorized_official_telephone_number": "308-432-3222",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "06923",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "410017859",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "410046153",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00390774",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "410046882",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9200332",
            "state": "SD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "06763",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9200910",
            "state": "SD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "09902",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9202140",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9203680",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Chadron Vision Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Chadron Community Hospital Corp. (Western Community Health Resources)
• Chadron Community Hospital Corp.
• Chadron Medical Clinic PC
• Chadron Medical Clinic PC
• Chadron Public Schools
• Chadron Volunteer Fire Department (Chadron Vol. Fire Fighters)
• Timothy Lee Chancellor, OD
• City of Chadron (Chadron Vol. Fire Fighters)
• Nathaniel James Clark
• Clear Sky Counseling and Consulting

• Optometrist in Chadron, NE
• Providers in Chadron, NE by specialty
• Optometrist in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.